Asthma in the older adult.

Objective: The older adult population is increasing worldwide, and a significant percentage has asthma. This review will discuss the challenges to diagnosis and management of asthma in older adults. Data Sources: PubMed was searched for multiple terms in various combinations, including asthma, older adult, elderly, comorbid conditions, asthma diagnosis, asthma treatment, biologics and medication side effects, and adverse events. From the search, the data sources that were utilized included peer reviewed scholarly review articles, peer reviewed scientific research articles, and peer reviewed book chapters. Study Selections: Study selections that were utilized included peer reviewed scholarly review articles, peer reviewed scientific research articles, and peer reviewed book chapters. Results: Asthma in older adults is frequently underdiagnosed and has higher morbidity and mortality rates compared to their younger counterparts. A detailed history and physical examination as well as judicious testing are essential to establish the asthma diagnosis and exclude alternative ones. Medical comorbidities, such as cardiovascular disease, cognitive impairment, depression, arthritis, gastroesophageal reflux disease (GERD), rhinitis, and sinusitis are common in this population and should also be assessed and treated. Non-pharmacologic management, including asthma education on inhaler technique and self-monitoring, is vital. Pharmacologic management includes standard asthma therapies such as inhaled corticosteroids (ICS), inhaled corticosteroid-long acting ß-agonist combinations (ICS-LABA), leukotriene antagonists, long acting muscarinic antagonists (LAMA), and short acting bronchodilators (SABA). Newly approved biologic agents may also be utilized. Older adults are more vulnerable to polypharmacy and medication adverse events, and this should be taken into account when selecting the appropriate asthma treatment. Conclusions: The diagnosis and management of asthma in older adults has certain challenges, but if the clinician is aware of them, the morbidity and mortality of this condition can be improved in this growing population.

Variation in airborne fungal spore concentrations among five monitoring locations in a desert urban environment.

Fungal spores are biological particles that are ubiquitous in the outdoor air. Spores of several very common fungal species are known allergens, with the potential to cause respiratory illnesses by exacerbating asthma and allergic rhinitis. The National Allergy Bureau typically has one monitoring station established per city to determine fungal spore counts for an entire metropolitan area. However, variations in fungal spore concentrations could occur among different locations. The objective of this study was to measure and compare airborne fungal spore concentrations in five locations in Las Vegas for the year 2015 to determine if there are differences among microenvironments in the city. Twenty-four-hour or 7-day air samples were collected from five sites across the Las Vegas Valley. Samples were analyzed with a light microscope for fungal spores and counts were converted to concentrations of spores per volume of air. Mixed-model methods were used to evaluate mean differences. Results showed that smuts (basidiomycetes) were the dominant spore type for all five sites during the spring season. Cladosporium species were responsible for the second most dominant spore type with the highest concentrations occurring during the summer and fall months. Results obtained from the five stations established in Las Vegas show that there are important variations among the sites regarding fungal spore concentrations. The data suggest that more sites and additional monitoring of outdoor allergens are needed to provide information necessary to inform the community of outdoor air quality conditions and their potential effects on public health. This study presents new outdoor fungal spore data for the southwest region of the USA, focused in the Las Vegas Valley.

Variation in airborne pollen concentrations among five monitoring locations in a desert urban environment.

The urbanization of the Las Vegas Valley has transformed this part of the Mohave Desert into a green oasis by introducing many non-native plant species, some of which are allergenic. Typically, one monitoring station is established per city to obtain pollen counts for an entire metropolitan area. However, variations in pollen concentrations could occur among different microenvironments. The objective of this study is to measure and compare pollen concentrations in five locations in Las Vegas to determine if there are significant differences between microenvironments within the city. Air samples were collected from five sites across the Las Vegas Valley over a 1-year period. Prepared slides were analyzed with a light microscope for pollen grains and converted into airborne pollen concentrations. Mixed model methods were used to determine mean differences. Tree pollen was the greatest contributor to the annual average airborne pollen concentrations (130 grains/m3) compared to weeds (6 grains/m3) and grass (3 grains/m3). The highest peak occurred in March 2016 (9589 total grains/m3). There were several differences among sites with respect to concentrations of individual tree species and for total weed and grass concentrations. We observed significant variations in concentration and composition among the five pollen collection stations that were established across the Las Vegas Valley. This study presented new outdoor pollen data for the southwest region of the USA, focused in Las Vegas. The results indicate that more sites and comprehensive monitoring of outdoor allergens are needed to provide accurate information to the community about outdoor air quality conditions.